Do dentists turn children away?

Wednesday, April 25th, 2012

Yesterday ABC played a story in their “Hidden America” series entitled “Do Dentists Turn Children Away.” It’s an emotional piece, for sure. It features many adorable low income kids in various states of dental distress and it levels some pretty serious charges at government and the dental community. Chris Cuomo, the story’s reporter, ended the story with, “…we went after them 5 years ago, it didn’t get done. This time we will not rest. This is unacceptable.” Diane Sawyer replied “And what about the good dentistsout there that want to help the 60% [of children on Medicaid without a dentist] who are living their lives right now and can’t wait…” Chris Cuomo went on to mention that some dentists are “doing the right thing…” The take home message I get from this report is that “dentists don’t care about poor kids.”

"not acceptable!"

This report comes on the heels of ABC’s coverage of “dental x-rays causing brain tumors.” It seems that dentists are getting all kinds of help from ABC news to tarnish our images this month! Like we needed it! So why won’t dentists take care of these needy kids? Is it that they don’t care? Or maybe they’re just unwilling to make less money while helping poor people. Either way, dentists are clearly bad guys.

I can only speak for myself. I’ve discussed this with other dentists often and most tend to agree with my perspective, though. I do take limited amounts of Michigan’s version of Medicaid dental coverage for kids/adolescents/young adults. Why don’t I take more? Here’s a few of those reasons:

limited services: This is probably the main reason that I’m hesitant to get more involved with these programs. I have a toolbox that I bring with me when I treat patients. (Not literally…I actually have an office!) I have a lot of different treatments to offer for different dental problems. Some of these tools work better in some situations, some work better for others. In extensive problems, some of these just aren’t workable. One of the things that frustrates me is that Medicaid will pay for a root canal procedure to save a tooth, but they will not allow you to restore the tooth appropriately after the root canal treatment! A lot of teeth that end up requiring a root canal have lost a lot of tooth structure. A filling is inadequate for these teeth, but that’s what is covered. If I go ahead and do what I feel as appropriate, the program will not cover it and it becomes the patient’s responsibility. Most patients aren’t willing or able to pay for the appropriate treamtent. So, my toolbox gets much smaller for patients using these programs.

limited payment: The fees that the Medicaid programs pay are low. That’s what everyone knows. The news programs always say this, but they never dig any deeper than that. To be specific, Healthy Kids dental in Michigan reimburses my office at about 50% of my regular fee. People hear this and think that dental offices make 50% less when they see kids on the Healthy Kids program. That’s not accurate. Most dental offices are small businesses run to make a profit. A dental office needs to collect a certain amount of money just to pay rent, utilities, equipment costs, employees…the basics. This is called overhead, and every business has it. You need to average a certain number of dollars for each unit of time in order to keep the doors open. If you don’t average this amount, the office doesn’t make a profit. Some offices can change their overhead structure by working more quickly, seeing more patients, using less expensive materials or paying their employees less to make up this difference. I won’t do that. I don’t want to have to change the way I treat patients to be able to participate with the program. My patients expect amazing service and a certain atmosphere and I’m not willing to sacrifice that. You may think that makes me a snob, but I think my patients appreciate it. So, when I see Healthy Kids patients, I’m working for free. The good news is, overhead is figured on an average, so I’m willing to take a loss on some patients. But as I mentioned before, I limit the number of patients I will see on the program.

ethical traps: Medicaid programs give each provider dentist a particular menu of procedures and their associated codes that are covered benefits. It could be tempting for a dentist to “overuse” a code that they wouldn’t normally charge separately for. I’m not saying that it’s wrong to do so and I’m not saying that it is common. All I’m saying is the that the temptation to “overcode” can be there.

All kids deserve healthy teeth!

dental prevention: Most dental diseases, especially in children are 100% preventable. These programs are at their absolute best when they are used for prevention: specifically early childhood examination and education of good dietary and brushing habits. Unfortunately, most people end up in need of these services after a child has problems, often really bad problems. The horse is already out of the barn at that point. These programs become much less helpful for those patients, and they will often need extensive care that can only be handled by pediatric dentists.

This is where I’m coming from. I’m not sure it would be a satisfying answer for Diane Sawyer. It’s a lot better TV when you can point the finger of blame at a particular group, especially when a lot of folks are pretty anxious about that group in the first place. The news media plays a story that riles people up, and then they forget about it. In the mean time, people look at dentists as greedy and uncaring. If you feel like dentists aren’t doing good things for poor kids, you need to ask yourself: in the same position, would you be willing to work for free? How much work would you be willing to do for free?

The Michigan Dental Association will be sponsoring it’s first Mission of Mercy in June of 2013. These amazing events allow Michigan dentists to see around 2000 patients in a weekend for no charge. Next year’s Mission of Mercy will be held on campus at Saginaw Valley State University. I’m planning on being a part of the 2013 MOM. I think this kind of event is an effective way to help people who might otherwise not be able to get dental care. So Diane Sawyer might have it wrong about dentists!

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